Using virtual 3D-models in surgical planning: workflow of an immersive virtual reality application in liver surgery

Boedecker, Christian; Huettl, Florentine; Saalfeld, Patrick; Paschold, M.; Kneist, W.; Baumgart, Janine; Preim, Bernhard; Hansen, Christian; Lang, Hauke; Huber, Tobias

doi:10.1007/s00423-021-02127-7

Cited by 60 publications

(64 citation statements)

References 16 publications

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“…Yang et al were the first group to compare different 3D modalities (3D PDF and 3D PR) to conventional 2D CT scans regarding tumor assignment and surgical resection planning, favoring the 3D PR reconstructions (32). The 3D VR model used in this study has first and only been published by our study group as a result of an interprofessional collaboration between surgeons and computer scientists (17). The often-used term of 'virtual model/virtual resection' used in other publications referrers to the standard 3D visualization on a 2D or 3D monitor, not to an immersive VR environment with VR headsets (26,33,34).…”

Section: Discussionmentioning

confidence: 99%

“…Also the VR applicationor rather the equipment for it is costly. But in contrast to the PR models, which are invoiced per case, the procurement costs for the VR devices are only incurred once (17). Furthermore, no relevant additional time is needed to create the 3D VR model due to a drag and drop application for STL files.…”

Section: Discussionmentioning

confidence: 99%

“…The 3D liver model can be moved, rotated around a vertical or horizontal axis as well as manual by means of the VR controller. Additionally, the model size can be scaled and the structures can be continuously adjusted to different degrees of transparency (solid to hidden) (17).…”

Section: Examination Modalitiesmentioning

confidence: 99%

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Virtual reality and 3D printing improve preoperative visualization of 3D liver reconstructions—results from a preclinical comparison of presentation modalities and user’s preference

Huettl¹,

Saalfeld²,

Hansen³

et al. 2021

Ann Transl Med

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Background: Preoperative three-dimensional (3D) reconstructions for liver surgery planning have been shown to be effective in reduction of blood loss and operation time. However, the role of the 'presentation modality' is not well investigated. We present the first study to compare 3D PDFs, 3D printed models (PR) and virtual reality (VR) 3D models with regard to anatomical orientation and personal preferences in a high volume liver surgery center.Methods: Thirty participants, 10 medical students, 10 residents, 5 fellows and 5 hepatopancreatobiliary (HPB) experts, assigned the tumor-bearing segments of 20 different patient's individual liver reconstructions.Liver models were presented in a random order in all modalities. Time needed to specify the tumor location was recorded. In addition, a score was calculated factoring in correct, wrong and missing segment assignments. Furthermore, standardized test/questionnaires for spatial thinking and seeing, vegetative side effects and usability were completed.Results: Participants named significantly more correct segments in VR (P=0.040) or PR (P=0.036) compared to PDF. Tumor assignment was significantly shorter with 3D PR models compared to 3D PDF (P<0.001) or VR application (P<0.001). Regardless of the modality, HPB experts were significantly faster (24±8 vs. 35±11 sec; P=0.014) and more often correct (0.87±0.12 vs. 0.83±0.15; P<0.001) than medical students.Test results for spatial thinking and seeing had no influence on time but on correctness of tumor assignment.Regarding usability and user experience the VR application achieved the highest scores without causing significant vegetative symptoms and was also the most preferred method (n=22, 73.3%) because of the multiple functions like scaling and change of transparency. Ninety percent (n=27) stated that this application can positively influence the operation planning.Conclusions: 3D PR models and 3D VR models enable a better and partially faster anatomical orientation than reconstructions presented as 3D PDFs. User's preferred the VR application over the PR models and PDF. A prospective trial is needed to evaluate the different presentation modalities regarding intra-and postoperative outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Virtual reality and 3D printing improve preoperative visualization of 3D liver reconstructions—results from a preclinical comparison of presentation modalities and user’s preference

Huettl¹,

Saalfeld²,

Hansen³

et al. 2021

Ann Transl Med

Self Cite

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show abstract

“…Virtual Reality (VR) has received a lot of attention and is increasingly being used for surgical planning, surgery simulation, and in structural human anatomy 3 – 5 . The immersive experience provided by VR is claimed by televised medical series to allow surgeons to better navigate and discover problems inside organs or other internal structures.…”

Section: Introductionmentioning

confidence: 99%

Investigating the utility of VR for spatial understanding in surgical planning: evaluation of head-mounted to desktop display

Hattab

Hatzipanayioti

Klimová

et al. 2021

Sci Rep

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Recent technological advances have made Virtual Reality (VR) attractive in both research and real world applications such as training, rehabilitation, and gaming. Although these other fields benefited from VR technology, it remains unclear whether VR contributes to better spatial understanding and training in the context of surgical planning. In this study, we evaluated the use of VR by comparing the recall of spatial information in two learning conditions: a head-mounted display (HMD) and a desktop screen (DT). Specifically, we explored (a) a scene understanding and then (b) a direction estimation task using two 3D models (i.e., a liver and a pyramid). In the scene understanding task, participants had to navigate the rendered the 3D models by means of rotation, zoom and transparency in order to substantially identify the spatial relationships among its internal objects. In the subsequent direction estimation task, participants had to point at a previously identified target object, i.e., internal sphere, on a materialized 3D-printed version of the model using a tracked pointing tool. Results showed that the learning condition (HMD or DT) did not influence participants’ memory and confidence ratings of the models. In contrast, the model type, that is, whether the model to be recalled was a liver or a pyramid significantly affected participants’ memory about the internal structure of the model. Furthermore, localizing the internal position of the target sphere was also unaffected by participants’ previous experience of the model via HMD or DT. Overall, results provide novel insights on the use of VR in a surgical planning scenario and have paramount implications in medical learning by shedding light on the mental model we make to recall spatial structures.

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“…In silico models can replace in vivo experiments for interventional training through realistic and immersive real-time simulation. Example: while we could not find direct comparisons, there are studies that use in silico training and other studies that use in vivo training on animals[20],[21].…”

mentioning

confidence: 99%

Possible Contexts of Use for In Silico Trials Methodologies: A Consensus-Based Review

Viceconti

Emili²,

Afshari

et al. 2021

IEEE J. Biomed. Health Inform.

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The term "In Silico Trial" indicates the use of computer modelling and simulation to evaluate the safety and efficacy of a medical product, whether a drug, a medical device, a diagnostic product or an advanced therapy medicinal product. Predictive models are positioned as new methodologies for the development and the regulatory evaluation of medical products. New methodologies are qualified by regulators such as FDA and EMA through formal processes, where a first step is the definition of the Context of Use (CoU), which is a concise description of how the new methodology is intended to be used in the development and regulatory assessment process. As In Silico Trials are a disruptively innovative class of new methodologies, it is important to have a list of possible CoUs highlighting potential applications for the development of the relative regulatory science. This review paper presents the result of a consensus process that took place in the InSilicoWorld Community of Practice, an online forum for experts in in silico medicine. The experts involved identified 46 descriptions of possible CoUs which were organised into a candidate taxonomy of nine CoU categories. Examples of 31 CoUs were identified in the available literature; the remaining 15 should, for now, be considered speculative.

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Using virtual 3D-models in surgical planning: workflow of an immersive virtual reality application in liver surgery

Cited by 60 publications

References 16 publications

Virtual reality and 3D printing improve preoperative visualization of 3D liver reconstructions—results from a preclinical comparison of presentation modalities and user’s preference

Virtual reality and 3D printing improve preoperative visualization of 3D liver reconstructions—results from a preclinical comparison of presentation modalities and user’s preference

Investigating the utility of VR for spatial understanding in surgical planning: evaluation of head-mounted to desktop display

Possible Contexts of Use for In Silico Trials Methodologies: A Consensus-Based Review

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